This is one of those issues where a generous fraction my countrymen and women have made spectacles of themselves. This is why the British ask me why Americans don't want health care, I imagine. That and all the fervent cries of 'Socialism!' about the British system.What's the truth about the Affordable Care Act? Well, it has made certain things easier. For example, people with pre-existing conditions can now get health insurance that doesn't have to come from their jobs. That right there is a HUGE step forward. It doesn't seem to have changed much for people who already had insurance through their jobs, especially where the insurance was already good insurance. (I know someone is going to disagree with me on this, but from what I can tell, those whose insurance plans changed had insurance that didn't cover the new required items.)I don't believe the ACA has made insurance affordable, though. I did the math. It is still expensive, even with tax credits. My take-away from researching getting coverage in two American states my boyfriend and I considered moving to, is that for freelancers like us, our out of pocket would still be around $10,000. That's on a 'plantinum' level plan, the best I could find. I think this will be true for anyone who has pre-existing conditions that require expensive drugs, or many doctor visits to specialists. On the moderate salaries required to qualify for the tax credits, a $10,000 deduction for health care looks a bit devastating.I'm not downplaying the importance of the ACA. It is, as I said before, a huge step forward. But it's just a step. A lot more needs to be done. I'm definitely not saying repeal it. But what I am suggesting is that big insurance companies shouldn't be in charge of what happens to health care. Insurance companies are, by and large, motivated by profit. Profit and people's health being linked is a dangerous model. It was dangerous before the ACA and it's dangerous after. I'm sure some are wondering about whether Medicaid fills the gap here. When a person's wages won't allow them to comfortably or even bearably buy ACA coverage, won't Medicaid do the job for them? Again, on investigation, not really. It will do some of the job for some people, but for others Medicaid will not cover certain important things. Last I looked, it won't cover organ transplants, for example. On top of that, individual states can deny expanded Medicaid coverage money, meaning a lot of people who might be eligible for it won't be. Texas is such a state. Montana. There are others.

What about Medicare for the elderly? Again, somewhat but not really. For example, in the time of life when deafness is most likely to be a problem, and when the enhanced ability to hear might help an older person stay mentally active and live longer and more independently, Medicare, the coverage for people over a certain age, doesn't cover the cost of hearing aids. How is this even possible? Does the NHS cover hearing aids? I'm told it does.

I do applaud President Obama for getting us into the twenty-first century, finally. But universal, single payer health care works. It doesn't have to work exactly like the British model and I don't think it would. American doctors have their ways of dealing with patients. I don't think this would change. Doctors need to be at the forefront of designing such a plan for America. Patients also need to be involved. It would also be helpful to have doctors from countries that already have such a system to give advice about what works and what doesn't.

No system is perfect and different cultures are going to have different expectations of their system. But right now, I feel that the American system is still being led by the money. Money is helpful, but it's not the most important thing. I note that here in the UK, everyone has equal access to health care. If you go to an NHS doctor, you have the same opportunity to get good care whether you're poor or rich or middle class. There are no disabled people in wheelchairs being asked to spend the night out in the cold in order to sign up for a spot at a free clinic.

It's hard to imagine yourself being disabled. But if you think about it, any of us is only an accident away from it at all times. What would happen to you if you suddenly couldn't work a full-time job? I'd like to live in a country, a world in fact, where people's medical care doesn't depend on their income.

And now I'll put 'Dear President Obama,' on top of this and put it in an email.